Abstract
Objectives: Penile surgery is commonly performed in pediatric surgical centers. There is no consensus regarding which analgesic method is most effective in controlling pain in these children.Methods: Consecutive children between 4 months and 16 years of age who underwent elective penile surgery were recruited. After inhaled induction of anesthesia, children were randomized to one of three methods of intraoperative analgesia: caudal block, IV fentanyl titrated to surgical response and spontaneous respiration, or dorsal penile nerve block (DPNB). All patients were given inhaled agents; fentanyl was added if either block was insufficient. Demographic data, analgesic use and pain scores were recorded by a blinded investigator in the PACU and ward. Pain scores, analgesic requirement, and recovery parameters of returning to normal activity level, eating, and voiding post-operatively for up to 4 days, were compared.Results: 116 children were recruited. Pain scores in the post anesthesia care unit were significantly lower in the DPNB and caudal block groups compared to the fentanyl group for the first 30 postoperative min. Pain scores and analgesic use were subsequently similar among the three groups for the rest of the study period. There was no statistical difference in time to eat, return to normal activity or in parental satisfaction scores among the groups. There was a trend toward earliest time to void in the DPNB group.Conclusions: Regional blocks most effectively controlled pain for 30 min after surgery. The choice of intra-operative analgesia protocol had no effect on later pain and recovery parameters.
Highlights
Penile surgery, including circumcision, revision of circumcision and repair of penile torsion, chordee or hypospadias, is commonly performed in pediatric surgical centers
There is a need to clarify which anesthesia option is most effective for postoperative pain relief while providing lasting enhanced recovery after penile surgery in children
We studied children between 4 months and 16 years of age who underwent elective penile surgery under general inhaled anesthesia using three different methods of analgesia: caudal block, intravenous fentanyl or dorsal penile nerve block (DPNB)
Summary
Penile surgery, including circumcision, revision of circumcision and repair of penile torsion, chordee or hypospadias, is commonly performed in pediatric surgical centers. Penile, pudendal and ring blocks, opioid and non-opioid systemic analgesics, as well as application of topical agents. Regional anesthesia provides effective pain relief with minimal effects on respiratory drive or hemodynamic stability; it is associated with occasional but significant complications, especially in infants, and has not been shown to be consistently superior to systemic analgesia in prospective studies [3]. There is a need to clarify which anesthesia option is most effective for postoperative pain relief while providing lasting enhanced recovery after penile surgery in children. The study hypothesis was that blocks, caudal and dorsal penile nerve block (DPNB), are effective in reducing intra-operative and post-operative pain
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